Emporia State University Emporia State University
Direct Deposit Authorization Cashiering Services
Emporia, KS 66801
Student’s Name: __________________________________________________________
Last First Middle
Lyon County State Bank
Account Number: _________________________________________
Authorization to Direct Deposit Refunds or Excess Financial Aid
Federal student financial aid can only be direct deposited into a student’s account by obtaining your written authorization to
deposit these funds. This form will allow Cashiering Services to direct deposit any refunds or excess financial aid to your
Lyon County State Bank checking account. Direct deposit is the preferred method of reimbursement because it is available
for student use prior to the issuance of a check.
I authorize Emporia State University to initiate a deposit to my Lyon County State Bank checking account listed above for
the net amount of my refund or excess financial aid and authorize Lyon County State Bank to credit the same to such
account. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S.
§ I understand that my direct deposit information will take effect following the receipt of this form by ESU
Cashiering Services in order to allow verification of my account.
§ I understand that I must verify my Lyon County State Bank checking account balance before using any excess
funds and I am responsible for any charges on my bank account.
§ I understand that I am responsible for immediate repayment of all financial aid funds disbursed if I do not attend
§ This authorization will remain in effect until ESU Cashiering Services has received written notification from me of
its termination in such time and manner as to give ESU and Lyon County State Bank a reasonable opportunity to
act on it.
§ It is my responsibility to notify ESU Cashiering Services of closed accounts at least one week prior to my next
§ With direct deposit, I authorize Emporia State University to initiate credit entries and to initiate, if necessary, debit
entries and adjustments for any credit entries made in error to my account.
COMPLETE THIS SECTION IF YOU WISH TO DISCONTINUE DIRECT DEPOSIT OR IF YOU CLOSE YOUR ACCOUNT
I wish to discontinue direct deposit to my Lyon County State Bank Account.
Deliver by mail to: Emporia State University Deliver by fax to: 6203416770
Cashiering Services Deliver in person to: Plumb Hall 104
Campus Box 4080
1200 Commercial Street
Emporia, KS 66801